Amer Durrani

Squamous Cell Carcinoma of the Temporal Bone: Clinical Outcomes From Radical Surgery and Postoperative Radiotherapy

Objective To review the treatment of squamous carcinoma of the temporal bone at a regional skull base unit for the period 1982–2012. Study Design Retrospective case review. Setting Tertiary referral center. Patients Sixty patients with primary squamous carcinoma of the temporal bone. Interventions Multidisciplinary team approach including surgical resection, reconstruction, and postoperative radiotherapy. Main Outcome Measures Disease-specific survival, overall survival. Results The 5-year disease-specific survival for the whole cohort was 44% (CI, 37%–51%). Multivariable analysis revealed nodal status, poorly differentiated squamous cell histology, and carotid involvement to be poor prognostic indicators. Conclusion Although the survival figures in this series are comparable with the best outcomes from other units, our experience would suggest improvements can still be achieved by reconsidering the selection of patients for neck dissection and temperomandibular joint excision in early stage disease. We also conclude that postoperative radiotherapy should be delivered to all patients, including surgical salvage cases who may have received previous irradiation. Finally, the minority of patients with poor prognostic features should be offered a more palliative therapeutic approach.

Correction to: 1 Versus 2-cm Excision Margins for pT2-pT4 Primary Cutaneous Melanoma (MelMarT): A Feasibility Study

In the original article John F. Thompson was inadvertently omitted as an author. The author list is updated as shown in this correction.

Individualised monitoring of patients with metastatic melanoma using plasma DNA

Abstract Background Circulating tumour DNA (ctDNA) is released by cancer cells into the bloodstream, which can be analysed via liquid biopsy. Analysis of liquid biopsy samples provides a real-time snapshot of tumour burden. After treatment, ctDNA concentrations can be low, making detection challenging. To study clonal evolution during treatment in patients with melanoma with high sensitivity, we sought to maximise the number of mutations targeted through individualised next-generation sequencing panel design. Methods 72 patients with stage III or IV melanoma were recruited to MelResist, a translational, multicentre research study. Serial plasma samples were taken from patients at monthly intervals during treatment (median 6·7 samples per patient). Clinical events were scored according to Response Evaluation Criteria In Solid Tumors (RECIST) (version 1.1) criteria. Exome and targeted sequencing were carried out on tumour samples at baseline and progression for nine patients, whose identified mutations were used to design an individualised targeted sequencing panel. Findings Multiple mutations per patient were tracked to monitor response to therapy. The percentage change in ctDNA mutant allele fraction after treatment initiation agreed with RECIST response for seven out of eight evaluable patients. ctDNA concentration strongly correlated with lactate dehydrogenase (LDH) concentration, a currently used measure of melanoma tumour burden ( r 2 =0·64, p=9·93 × 10 −7 ). ctDNA dynamics were compared against rising LDH, which showed a median lead-time to biochemical progression (rising LDH) of 70 days (IQR 28–152·3). Targeting multiple mutations could improve sensitivity compared with individual mutations. Interpretation In this study, we applied an individualised targeted sequencing panel on ctDNA from patients with melanoma. As tumour sequencing becomes more routine, individualised sequencing panel design might become more feasible, facilitating a more sensitive approach for ctDNA analysis than targeting individual loci. Tracking clonal evolution during therapy non-invasively may facilitate personalised treatment decisions with molecularly targeted agents. Funding Cancer Research UK, Lewis Family Charitable Trust, Addenbrookes Charitable Trust, Cambridge Cancer Trials Centre, NIHR Cambridge Biomedical Research Centre and Human Research Tissue Bank.

Cervico-facial necrotising fasciitis due to Candida albicans

Necrotising fasciitis of the face is a rare disease, associated with a high morbidity and mortality. Necrotising infections due to Candida albicans as the sole causative organism are extremely rare; more commonly the organism is found as a saprophytic constituent of a polymicrobial infection. We present the case of a 57-year-old man who developed cervico-facial necrotising fasciitis following a routine dental extraction. The only organism identified on tissue culture was C. albicans. He required extensive resection of the soft and bony tissues of the left side of his face and neck and subsequent free flap reconstruction. We discuss his initial management and primary reconstruction and review the literature regarding fungal necrotising fasciitis.Level of evidence: Level V, therapeutic study.